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HomeMy WebLinkAbout0067 MELBOURNE ROAD �7 Melbzoortw e6,� Town of Barnstable erm.it.0-G 1 �—e � Regulatory Services ate: '::A ptrI.KE rp4. Thomas F.Geiler,Director � �L Building Division Fee: saxxsr"L% Tom terry, Building Commissioner a� 200 Main Street, Hyannis,MA 02601 www.town.bgrnstable,ma.us Office: 508-962403 8 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: �� �L�DS Phone:sc� -CIO -34'15 install at: (1 AthugrtQ Qd Village:.C1)qn Map/Parcel: "2) C--'-L4'b Date:�� _ Stove A. 4&1 Used B. Type; RadiaVroa ircu Dm�; ��Dra ►�J C. Manufacturer:� Lab. No.1,5-S '31 - D. Model.No.: YYK " ° r Chimney A. New/ istin �exi- ize e note date of last cleaning)B. Flue S C. Ale other appliances attached to Flue? .YA D. Pre-fab Type and Manufacturer I«►(cs `r �T E. Masonry: ine mined Dearth A. Materials: v:Zv1e. 4c..Q_ 8- Sub Floor Construction: Installer n l Name: Address: rIaO �cov'tie a A A,-�aol\,0A Phone: loL�- 1lfl °19 Location of Installation: cv(vi H.I.0 Registration#_1 Construction Supervisor 0 o l4 OR check� Homeowner Installing,no license re uired APPLICANTS SIGN TURE APPROVED BY: 27 /3 Please make checks payable to the Town v Barnstable *This constitutes an official stove permit after inspection, photographed, and approved by Ike Building Inspector Q:fornns'Stove Rev 103107 The Commonwealth of Massachusetts Pant>orm ry Department of Industrial Accidents - Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Cape Cod Pond Supplies Inc/The Stove Center Address: 1220 Route 28A, PO Box 700 City/State/Zip:Cataumet, MA 02534 Phone #:508-564-7663 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑✓ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no ellet stove install employees. [No workers' 13.❑✓ Otherp comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:MA Retail Merchants WC Group Inc Policy#or Self-ins.Lic.#:014005032148113 Expiration Date:01/01/2014 Job Site Address:67 Melbourne.RD City/State/Zip:Hyannis MA 02601 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby certi under thy n and enalties o_f eerjurythat the information provided above is true and correct. Si nature: Phone#:508-564-7663 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts- Department of`f!u 31+c Siif�R� Board of Building Regulations and.St#jndard Construction Supervisor SpecWlly License License: CS SL 105742 . Restricted to SF SCOTT WILLIAMSON 579 TREMONT ST REHOBOTH, MA 02769 Expiration: 10/23/2013 („nnui..imscr Tr#: 105742 �� VIP, Cf 1111AA60) 116CIAII•-/0-AK,j JaC/I f/';e Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 1'7-3250 Type: Office of Consumer Affairs and Business Regulation xpiration:-_:9/20%2014, Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 . CAPE COD POND SUPPLIES JNC THE STOVE CENTER ` ROBERT HANFLIG / 1220 RTE 28A CATAUMET,MA 02534 Undersecretary Not valid without signature t s I JD CERTIFICATE OF LIA ILITYINSURAN 04-02-20-1 3 I THIS CTRTIFICATEM, MSUED AS&MAT UER Cr G III QW&ATION 0 NILY A N'D C 0 N F ERS NO Fli HTS U P0 N T HE C ERT IFML�TE HO LO E R.TH 1-5, CERTIFICATE DGUS, MDT ARFIRMAUVELYOR NEGATIVELlir AMIND, EY7-F-11V OP. ALTER -rr-.E COVERAGE.A-.::FORDED BY THE POLICIES EEILMN. THIS CERTIFICATE:0F INISURIA"N rllEl DOES NOTCONSTITUTE A CO NTRACT BETWEEN THE r5SUlNG IUSUMERISL AUTHOPIZED REPREGENITATWOE:OF, PRODUCER,.AND THE-CHTTIFlUiTE HOIDEA.. IMPORTANT: III'Em-marblic-ate tinber,is,art ADDITIOMAI-04SURED,ft policyliesl:rrfj--,t be erdons�k. It SUBROGATION 15 WAIVED.sut�ject to thatenn, conthumm ae,pcifiry,caftNA uranc P-gifirean erWwwmanf- A statemme—M on this certificaiecloes ml cmier rigrAs to tr* caffif=te ho)fau irm Teu at umh embi5mmeatl'i- NAME- COMPLETE, BEN"REPIT SOLUTIONS/PAC. 2508,37 4 4 1 6-1,12, PG BOX 33015 SAN ANT01410 TX 78265 Twin City Ina Co AS= PAINT-C.RP=—, !NIZ DBA PELLET STOVEE SEOVICE 94SWORZ 579 TPMMITT ST R&MU,il t c-CAMPAGES CERCIFICATE NWIWEIEF." PEEIV&ON NUMBER: V44IS IS,TO UNIPf TRAT 714E FOLICIES,OVINSUFASKA USTIL-D MBW kKVL W--N ISSUMI TO TK INSURED :"ED AR VE MP TRE PGUCY PU400 IrMEATED. kgraummms Ame anufRUORENT, TRUA OR IC NDMON OF AWYCONTFACTOR OTW-R VJCUM ENT 'A 7H RRS,-ECT 10 WRUC14 THIS CWWlIrA.n--'WY K":MCI@ Wl WAY PERTARA TIME: W913FANCt AFnRDW BY TAE POLICIES DESCITER'D i4E3;UN IS WKIECT TO &I-1 THE TERMS, UFATSS4GIV NIA,AY 1ANWSPER?PURKOID2V W.0 CLAW& AWL Autm AIR MT, JWZV xamwd At"34f Vr" affiiw" GFAEW UAUAV 1:1AU OCCIFUERCS ==1 j MJN t TUMUMAL W-*PXI E Ej13 M3V-lW.L.AUV VLkW GENURC Acy--arATT L Arcmakff wMAM-Lp"WE �'R'00J,-T B-CWRLIP AM —7-ow-W El'J'RMV-T, Ll VOC AURWRTUE,lmaujw C.GVE 1,13 SlUal it y lim Rwy m=liml) I ALTIGS; AIMS M ZWt K Lj n AIL GOM ' 'ZACF or-CMITIAZi WOKM f-A"WAMV m-Affmallis Wamy V A N x Im. U�EAZA ACCIDN'T A =MW WA m4fir I&A U, , 96-121orml-S,CK WiTTM5.Ldm U, NSEA SE P;-;UCf LUTT s 5',)L') fj 1,1 ID Li 0 —,dr— Those usual to the. Insured's Operations. CURTIFICMATE RIOLDU,, CANCELLATION S.IHOULD ANV OF THE ABOVE �&-, MBED POUCIES BE.04ANCELLEED BEF0,RE THE EXPIPATION DATE;THEREG.E:. NOTICE:WILL BE DEUVERED IN ACCORDANCE WfTH THE FIOLICY1,NROVIS 0NS. ALTHOW0 JEMEWs A WIT 1 q-aS-20 I G ACORD CORPORATION. All rights reserved.. PCORD,25 f"lQiW+ IMeACURD name,and kago Eire regf.ste-red:rwarks,ol'ACORU, s � Cape Cod Pond Supplies Inc. 1220 Route 28A, P.O. Box 700 Cataumet, MA 02534 Phone 508-564-7663 Fax 508-564-7950 September 9, 2013 Town of Barnstable Building Department 200 Main St Hyannis MA 02601 This letter is to notify the Building Department that we have hired the sub-contractor listed below for the installation of a pellet stove insert located at, 67 Melbourne Rd in Hyannis: Scott Williamson 579 Tremont St Rehoboth MA 02769 CSL# 105742 Thank you, ce14 Robert Hanflig Town of Barnstable ` Regulatory Services Thomas F.Geiler,Director s •` Building Division Tom Ferry,Building Commissioner 200 Main Street,Hyannis,MA 0260I www.town.barnstable.mams Office: 508-862-4038 pax: 508-790-5230 Property Owner Must � Complete and Sign This Section If UsinLy A Builder I, as Comer of the subject property hereby authorize&AArk,sikZwle-to act on my behalf, in all ratters relative to work authorized by this building permit application for mkl&ourp Q (Address ofJob) L.gnature of Owner--_____� ate Print Name If Em ert; Owner is applying for permit lease corn ;lete the -l�--X. P P P P P � Homeowners License Exemption Form on thee reverse side. QXORMS:EIWPIERPERMISSION r , � r7 CERTIFICATE OF LIABILITY INSURANCE DATE8i20/13 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Association Benefits Insurance Agency CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Wilmington, ingtoBalla ,M St,Suite 1 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY Wilmington,MA 01887 THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# Insured INSURER A: MA Retail Merchants WC Group Inc. Cape Cod Pond Supplies Inc INSURER B: 1220 Route 28A PO Box 700 INSURER C: Cataumet,MA 02534 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEDHEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY ADD'L EFFECTIVE DATE POLICY EXPIRATION INSR LTR INSRD TYPE OF INSURANCE POLICY NUMBER MM/DD/YY) DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE = OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $ PRO- POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY—EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS LIABILITY To LIMITS ER ANY PROPRIETER/PARTNER/EXECUTIVE E.L.EACH ACCIDENT A OFFICER/MEMBER EXCLUDED? $ 1,000,000 Ifyes,describe.under NO 014005032148113 1/01/13 1/01/14 E.L.DISEASE—EA EMPLOYEE SPECIAL PROVISIONS below $ 1,000,000 E.L.DISEASE—POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATIONDATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO 200 Main Street MAIL 35 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED Hyannis,MA 02601 TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE r bo 67 Melu rneRd,H s `LL 9/25/13 71 ZI go , , _ s , r 4 .a y . z _TT 9 � n a t x " yam, ,^".^ 1V .w. .ar w �vrc —Assessor's map and lot number, ......�.�.. ..�"v..?.�,��% EI)P/ IC�_ NIUS'� R�E r, ,_ j INSTALLED IN COMPQ roe♦ Sewage Permit number ...:....:......... / l:� WITH TITLE ` : NVIR®NMENTAL C • �� e = House number ............ roes $L � .................. ............. ..:........:..:........... e®vvN REGIiL/�aTl TOWN OF BARNSTABLE BUILDING IN SPE C T 0 R APPLICATION FOR PERMIT TO ... 6VI�.....-2�:. Ry....:... ,e. l.G1,1�/�t�,,,,,,,,,,,,,,,,,,,,,,,,, TYPE OF CONSTRUCTION ............ . �C1L'..............`.... ...................:................................. ....................... ...19 TO THE INSPECTOR OF BUILDINGS: The .undersigned hereby applies for, a permit according to the following information: Location ..... . .�a .......� ?._./...... .ne ....... ..o!.,.: .1 .�.it�t .1.sic .. l..i......�..../�'1a. .:................... Proposed Use .. .P.�L.C?. &e� ?L.GL..................................... .................................................................................................. ZoningDistrict ......... ................Fire District................................ � .�1/l(fl... ................................... .1 a.. ...a....Address ...........................:.............:...............................:.......... Name of Owner �>..<f#/01�1......... Name of Builder- XI—C-A-R-Q.Q........./y1.(--. CC./.�Q.5.....Address .................................................................................... I� •�" zj' f r► E'L l Lcv l-oQ j v r;ev On. CLv I w l.Ce Nameof Architect ..................................................................Address ...............................................................................:.... Numberof Rooms ...................�®........................................Foundation ......... ..................................... Exterior .............� hP....... ...:..........::.............Roofing .... .S hg.L .,.... `l!jJ ........................ r i Floors ..a. ......... ??..C'.......C.fta ....:...Interior .........5Y1.f.-eJ...... P.O..G. .....................................[� Heating~ I,!4 ..:".....� .......................Plumbing ..:......... ......$f....��1'"".�'..��Ce/yv0 .... Fireplace ................. ...........(,../�.d-%..C. .�.........................Approximate Cost ...............-/, �fT�1��.:........................ � Definitive Plan Approved by Planning Board _ I ___________19 Area :Z Z ........... �. Diagram of Lot and Building with Dimensions Fee . . SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . vGGf /1�1I ... ............................ 15 MEDERIOS, RICARDO No ... Permit for ........... tSin le Family„ Dwell ........... location ... ......6:L N 6"1jP.Q.j4.V Tie...Road ...............We.s tH ... vAnn.i.sp.qA�t..................... ..... ..... Owner .....Ricardo..Med .................. .........qr1.0.q os................ Type of Construction ..EKA09............................ ................................................................ Plot ............................ Lot ............................. Permit Granted .......Au93A§!...1.1..........19 87 Date of Inspection ..................................19 Date Completed .....tl. . . ........19fr 7' C CIA-, lAssessor's map and, lot number .............................................. / Of THE TO r Sewage Permit number ...........�" ....... Z BAUSTADLE, i •'�y House number ......................._................................................ ro NAM / O sb39. `00� MAI TOWN -OF BARNSTABLE { BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... .......:"�.... /�!? ??4 ...........` r/c..//..� *� ........................... .. TYPE OF CONSTRUCTION ................ '. ?.................;d; ,n//.7 .............................................................. . ........19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....�.r,. y `-a (1'1 / } r �2 n n /? d Al, ! t , r, n d, S n n ' i l)� ....................... ..... ... ........................................................... .... .�.. ... .................... ................... Proposed Used.r.... !?��'.^..r, �.�l.. ................... J � Zoning District ............Fire District Name of Owner Address ........................................... y Name of Builder ......... ......Address .................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................!� t�. :!..a'.P.. . :.:........................................... . ..............................................Foundation ....... `Exterior ...........: �C ..... r . .. ...............................Roofng ... . a......... .,r............................. ; . . .... Floors ... . ...........I......F..; t� a?-� ' !.:`.+.C'...........Interior l.n t .... E?..<.... .......: �. ...... ................. ................................ U • Heating .. .......... ....... 1 . .....Plumbing �. lf, C; . (ten................P .....�.........: 't j t ' .%../....�...a..................................Fireplace ................... f .....Approxi mate'Cost .. ................. XNk Definitive Plan Approved by Planning Board _____' _`__`+_ !___________19 ____. Area � � 2—r `.............. ................. Diagram of Lot and Building with Dimensions Fee /............... ...... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH `v OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations,ofthe Town of Barnstable regarding the above construction. '` Name GC'!a!����� /i?s ;.:�'�"............................... MEDERIOS, RICARDO A=268-248 No ... Permit for ...T.w.o...Stctry......... .........S.i.0 9.Ie...F�mi.ly...Dxelllag............ Location ......6.7..Melbcxurae...Road .................W.eat..Hy.annlapart.................... Owner .........Ri.ciar.do..Me-d.eir.Qs............... Type of Construction ..........................................rae ................................................................................ Plot ............................ Lot ................................ Permit Granted ...........Augus.t...1.1,...19 87 Date of Inspection ....................................19 Date Completed ......................................19 A0. .t ,.TMEr, TOWN OF BARNSTABLE 3 068 � Permit No. ................ BUILDING DEPARTMENT i D�Y1R I TOWN OFFICE BUILDING Cash ................ YNl � HYANNIS,MASS.02601 Bond A CERTIFICATE OF USE AND OCCUPANCY Issued to RICARDO MED'EIROS Address lot #5,0 67 Melbourne Road, West Hyannisport USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .......Ju1.Y..1............. 19.....88........ ............� ...�...... -,.,_._.__. Building Inspector 7 / - 8B HATE - CONTINUATION OF ROAD BOND BUILDING PERMIT The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering•.Section of the Department of Public Works. loam and seejshoulders as,,soon as eather permits. . � c other (,explain) `-S D dP ORAL LOCATION ; (a ( SIGNED ner/Contractor ENGINEFING AUTHORIZATION , I I 44 — I. - - 7 ` _ _i. i- �_ .. i ..1 ,- i i I I_.. _I J _. ._.; :.yY 1 j 1 " ..,. , : ; . ..... , . . f21 ._( �. _ �...� �_. - of 50• - - -.- -•---•...__�...._ ,---- ••- ;.-r- �__._._.. � - .._ � --• �(� 4 I i _ _ : ! + . i 30, E 4 ,.. I. 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